Delivering bad news. It’s part of our job. “Your child has cancer” is by far the worst. “Your child is terribly sick and we don’t really know exactly what is going on but we’re doing everything we can” is up there. And occasionally, just occasionally, “you have a fracture and will be in a cast for at least 6 weeks” can just about do it too. We get so caught up that sometimes we forget that even the seemingly simple things can impact someone so much. And that’s exactly what happened the other day. I think I ruined a teenager’s life.
Now I know on paper I’ve rolled my eyes about seeing fracture after fracture before, but sometimes on a difficult mentally exhausting day with really sick kids, horrible family situations and complicated medicine a good old fracture is a blessing. Something we can identify, and something we can fix! (most of the time) If only all of medicine was that easy right?
So I went to see a 17 year old who had a hand injury after football. Easy! He was so tall his feet stuck over the edge of the bed (he was much taller than our usual patient population!), arm in a sling, mud EVERYWHERE. His wrist was swollen and he refused to move it so clearly something was going on. We had to do a few X Ray’s to figure out which bone was broken and how to treat it. Turned out it was the scaphoid. It’s an important one to make sure it heals well because there is risk of loss of blood supply to the bone, a complication we’d really like to avoid. So I pottered in to the room and told the patient and his mum that he’s broken a small bone in his hand, we’ll need to put it in a plaster to be seen by the Orthopaedic surgeons in a week or two and will likely be in a cast for at least 6 weeks.
This stoic teenager’s face dropped. It looked like his world had collapsed around him. He put his head in his hand (his non-broken left hand) and I think there may have even been a tear, at the very least he was choking back tears. I myself needed a second to process this. Of all the news I had broken to patients and parents that day this to me was most definitely the better problem to have. But of course he didn’t see it that way, at that moment I realised I had just ruined that teenager’s life… He was a star footballer and had some big games coming up. He was really good at basketball and selections were around the corner. He was in year 11 so had a lot of assessments and of course he was right handed. He was one of few selected for a leader’s camp interstate, leaving in a week, and involved a lot of sport. AND he was going to be a partner at the upcoming school debutante ball. Suddenly this tall, strong, confident 17 year old was reduced to nothing but this fracture which was going to ruin everything. He didn’t care that he didn’t need breathing support like the child I had seen before him, or that he wasn’t having ongoing seizures like the child before that, or that he wasn’t on a liver transplant list waiting for an organ donor so he could live to see his fifth birthday… he didn’t know about any of that so why should he care. All he cared about was that all the things he had coming up in the next one two months were over before they even began. That’s all he knew. One blow to the hand and everything he had worked towards was done with.
I felt so bad for him. To me this was “just a fracture” because in the grand scheme of things that I see go wrong this was definitely the best-worst thing that could ever happen. But it’s all relative. I realised that to him, this is probably the worst thing that has ever happened in his life. For a popular, sporty, intelligent 17 year old otherwise well kid, breaking a bone and being out of action for weeks to months is probably the worst thing he has had to face to date. It turned out that “just a fracture” was much much more than that.
So I did the best I could to make the most of a difficult situation for him. I convinced the Orthopaedic surgeons to squeeze him in to clinic so he could go on camp, wrote a detailed letter to school to give him permission to travel interstate, and we even had a laugh about how cute the cast will look in deb photos! I got smiles out of him by the end of it, and he even started giving me some cheek so I knew he was ok. He knew he would be ok too. For a minute though I’m sure it felt like his world was collapsing around him.
It was a good lesson on remembering that no matter how small, or trivial something may seem to one person, it may just mean the world to someone else. Although this is just a very honest recollection of what was going through my head at the time, I do always have that work ethic when I see patients and families – but this kid really bought it home. That’s why no matter what we do, not just doctors, anyone for that matter, we need to remember that we never really know what goes on behind closed doors. We don’t know what everyone else’s priorities are, how much something means to someone. So we always just need to be a bit understanding and forgiving because you never know, something so simple to us might just turn someone else’s world upside down.
Be healthy. Be happy. Be kind.
Dr. Nelu x
(Photo credit: http://www.bbc.com/news/health-26224812)